Case Management

CMW Tip: What to do when a patient refuses a bed

Case Management Weekly, January 20, 2010

Q: What should I do in the following situation? A patient no longer requires hospital level of care and a bed is available in the nursing facility. However, the patient and family are refusing the bed because they don’t like the nursing facility?

A: First, listen to what the patient and family are saying to ensure that they don’t have a concern you have not considered. The facility must be able to render the appropriate care. Confirm with the attending physician that the patient still no longer requires acute level of care and is ready for discharge. If the decision to refuse the bed is to wait for a particular bed, you will need to ask utilization review (UR) staff to validate the patient’s discharge readiness. The discharge planning or UR staff, after conferring with the patient’s physician, may decide to issue a Hospital Issued Notice of Noncoverage (HINN). If the patient is a Medicare beneficiary the discharge must be complete before issuing a HINN or a discharge notice for a Medicaid beneficiary.

This week’s tip is adapted from Discharge Planning Guide: Tools for Compliance, Second Edition published by HCPro, Inc. For more information on this book or to order your copy, visit the HCMarketplace.

Do you have a question about a case management topic? Send it to editor Ben Amirault at An answer to your question might appear in a future issue of Case Management Weekly.

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